Healthcare systems launch pioneering data-exchange collaborative

Six healthcare systems have announced a first-of-its-kind partnership that will see them joining the Dartmouth Institute for Health Policy and Clinical Practice to share data on outcomes, quality and costs across a range of common and expensive conditions and treatments.

The group, which includes Cleveland Clinic, Dartmouth-Hitchcock, Denver Health, Geisinger Health System, Intermountain Healthcare and Mayo Clinic, will determine best practices for delivering care for these conditions and will rapidly disseminate actionable recommendations to providers and health systems nationwide. In addition to achieving better quality and outcomes, the collaborative intends to improve the efficiency of standard clinical care delivery to reduce the per capita cost in these conditions and to keep costs in pace with the consumer price index.

The collaborative will initially focus on eight conditions and treatments for which costs have been increasing rapidly in recent years and for which there are wide variations in quality and outcomes across the country: knee replacement, diabetes, heart failure, asthma, weight loss surgery, labor and delivery, spine surgery, and depression, which together amount to hundreds of billions of dollars in direct medical costs each year.

"The intractable problems of quality and cost cannot be solved without getting to the fundamental issue of how we deliver healthcare in this country," said Brent James, MD, chief quality officer at Intermountain Healthcare and executive director of the Intermountain Institute for Health Care Delivery Research. "By collaborating to gather data and identify the most effective care models, we can address variation in treatment, cost, and outcomes to give patients the quality care they need and bend the cost curve down in a meaningful way."

The six healthcare systems, with a combined patient population of more than 10 million, will share data on outcomes and clinical protocols for the selected conditions and treatments, to arrive at optimal care models. The collaborative aims to see these best practices replicated across the country.

The Dartmouth Institute will coordinate data sharing and analysis, and report results back to the collaborative to inform development of best practices. The Dartmouth Institute has twenty years of experience analyzing Medicare claims data and disseminating the findings. This same expertise will be applied to the work of the collaborative.

The collaborative will first analyze total knee replacement, a procedure that is performed more than 300,000 times a year in the U.S., with a cost that ranges on average from $16,000 to $24,000 per surgery. Simultaneously, collaborative partners will build the metrics to study the care of the other selected conditions at their centers and arrive at best practices. Work to define best practices in diabetes and heart failure care will begin early in 2011.

"If we know that the treatment path for diabetes at one institution results in better clinical outcomes, higher patient satisfaction, and lower overall costs, then there is knowledge to be shared and replicated in other institutions," said Robert Nesse, MD, chief executive officer of Mayo Clinic Health System and member of Mayo Clinic's Board of Trustees. "We need to learn from each other and put systems in place that ensure that every patient gets the very best, most appropriate care, every time."

"There is broad support from other healthcare systems across the country who want to participate in the work of the Collaborative," said James Weinstein, MD, director of the Dartmouth Institute. "It would be enormously valuable to have the broadest geographic and demographic representation in the sharing of outcomes and experience."

Developing models to reduce cost, while improving quality, is just part of the equation. An equally important goal is to impact the clinical care of patients across the country by disseminating these models quickly and working with providers and health systems to adapt them to local conditions.

"In my view, the most critical piece of this initiative is the transfer of knowledge to other health systems," said Glenn Steele, MD, president and CEO of the Geisinger Health System. "We need to aggressively implement a rapid learning network to disseminate our work and assist other systems in implementing these best practices, especially the highest cost systems."